Welcome to Understanding Prostate Cancer. My name is Ken Pienta, Professor of Urology and Oncology at the Johns Hopkins School of Medicine. I have been studying prostate cancer and treating patients with prostate cancer for over 25 years.
Over 1,000,000 men worldwide and 230,000 men in the United States are diagnosed with prostate cancer every year. Three hundred thousand men worldwide and 30,000 men in the US are dying from prostate cancer every year. As people live longer, the incidence of prostate cancer is rising worldwide and prostate cancer continues to be a major health problem. Thanks to years of dedication and commitment to research we’ve made enormous advances in the treatment of prostate cancer, But there is still a lot of work to be done. In this Understanding Prostate Cancer course, I will provide an introduction to the biology of prostate cancer as well as how it is identified and treated at various stages of the disease.
I've put together this course in order to introduce you to the essentials of prostate cancer.
By the time you finish this course you'll be able to
 Define risk factors for prostate cancer
 Understand current prostate cancer screening guidelines
 Understand prostate cancer staging
 Understand treatments for localized prostate cancer
 Understand treatments for advanced prostate cancer
 Understand treatments to alleviate the symptoms caused by prostate cancer
This Understanding Prostate Cancer Course should be helpful to anyone who wants to develop a deeper understanding of prostate cancer biology and treatment. It should be useful to students who are interested in a deeper understanding of the science of cancer. It should also be helpful to health care providers, data managers, and educators who wish to develop a better understanding of prostate cancer and how it affects individuals. The course is not designed for patients seeking treatment guidance. For those of you who might be thinking about a career in cancer research or patient care, I hope this course will inspire you to pursue that path! The course is divided into five modules organized to facilitate learning.
I'm glad that you decided to join this course. I hope that you will develop a basic understanding of prostate cancer. I hope that it will help you in whatever field you work. If you are a student, I hope that what you learn here will help you begin a career in cancer biology research and contribute to the worldwide effort to save lives.

Taught By

Kenneth J. Pienta, M.D.

The Donald S. Coffey Professor of Urology

Transcript

Erectile Dysfunction or Impotence. Erectile dysfunction or ED occurs in nearly 100% of men on castration therapy. Low testosterone leads to decrease libido. Lack of desire to have an erection. It also leads to shrinkage of the penis over time. Shrinkage of the penis can also result from nerve damage from radical prostatectomy or radiation treatment for primary prostate cancer. Therefore, there are multiple reasons for ED in men with prostate cancer. There are several therapies to help overcome erectile dysfunction in man with prostate cancer. Alprostadil is a type of medicine that causes blood vessels to expand, increasing blood flow throughout the body. By increasing blood flow to the penis, alprostadil helps facilitate an erection. It can be injected directly into the penis with a tiny needle, or it can be used as a suppository placed at the opening at the tip of the penis. Both injectable alprostadil as well as the suppository form are available to patients. It has been found that the injectable form causes an erection firm enough for sex in approximately 80% of men regardless of age or cause. The suppository form is generally not as effective. It produces an erection in about 30% to 40% of men with erectile dysfunction. Another class of medicines used in ED are the phospodiesterase type five or PDE inhibitors. These drugs have become household names. Cialis, levitra, viagra, all work by this mechanism to cause erections. Part of the physiologic process of erection involved the release of nitric oxide, NO in the blood vessels of the penis as a result of sexual stimulation. NO activation leads to smooth muscle relaxation in the blood vessels, resulting in increased blood flow and an erection. This requires sexual stimulation. For this reason these drugs work less well in men on ADT. They simply did not have a libido, and therefore these drugs often fail when tried in men on hormonal therapy. There are non medical ways to approach erectile dysfunction. One way is a vacuum constriction device, commonly called the penis pump. A VCD is an external pump with a band on it, that a man with ED uses to get and maintain an erection. The VCD consists of an acrylic cylinder with a pump that may be attached directly to the end of the penis. A constriction ring or band is placed on the cylinder at the other end near the body. The cylinder and pump are used to create a vacuum to help the penis become erect. And then the band is then used to help maintain the erection. The study suggest that about 50 to 80% of men are satisfied with the results of using a vacuum constriction device. Finally penile implants can be use. Penile prostheses are implants offer a permanent solution to erectile dysfunction. These devices are either malleable or inflatable. The simplest type of prosthesis consists of pair or malleable or bendable rods, that are surgically implanted within the erection chambers of the penis. So overall for erectile dysfunction, unfortunately the household name drugs like cialis and viagra, don't work very well. Because of the lack of patient libido. Drugs like aprostadil the VCD's or penile implants all work independently of libido and offer hope for an erection in men with prostate cancer.

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